| 摘要: |
| 目的 探讨右美托咪定对老年患者全麻术后认知功能（POCD）的影响。 方法 选择全麻患者 91 例，性别不限，年龄 63～80 岁，ASAI 或Ⅱ级，采用随机数字表法将患者分为两组：右美托咪定组（D 组）46 例和对照组（C 组）45 例。常规咪达唑仑,顺苯磺 酸阿曲库铵,舒芬太尼,依托咪酯行麻醉诱导，诱导前 10min，D 组静脉输注右美托咪定针，负荷量 0.5滋g/kg，再分别恒速静脉输注右美 托咪定针 0.5滋g·kg-1·h-1 至术毕前 30 min，C 组采用同样方法静脉输注等容量 0.9%氯化钠注射液。记录舒芬太尼、瑞芬太尼和异丙酚 用量。记录两组患者手术时间、出血量、血压、尿量及输液量。于术前 1d、手术结束后 1、3、7d 时采集右颈内静脉血样，采用免疫夹心 双抗酶联免疫吸附法（ELISA） 测定血清高迁移率族蛋白 1 （HMGB1）、TNF-α、IL-1β、IL-6。并于上述时点采用简易智能量表 （MMSE）对患者进行认知功能测试，记录 POCD 的发生情况。 结果 与 C 组比较，D 组瑞芬太尼针和丙泊酚针用量明显减少（P＜0.01），舒芬太尼用量差异无统计学意义（P ＞0.05）；D 组 TNF-α、IL-6、IL-1β 和 HMGB1 水平在术后 1、3、7d 三个时点均明显降 低；D 组 MMSE 评分升高（P＜0.05）。C 组、D 组发生 POCD 的例数分别为 13 例和 4 例，其发生率分别为 28.9％、8.7％，C 组显著高于 D 组（P＜0.05）。 结论 右美托咪定可以通过抑制机体炎症因子释放，预防老年患者全麻术后 POCD 的发生。 |
| 关键词: 右美托咪定 术后认知功能障碍 老年患者 |
| DOI： |
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| 基金项目:浙江省医药卫生一般研究计划 |
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| Effect of dexmedetomidine on cognitive dysfunction in elderly patients undergoing abdominal operation under general anesthesia |
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WANG Wenwei,ZHOU Chunlian,YE Keping,WANG Lizhu,YE Qigang,FU Xinchun,WANG Huaqin
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Taizhou First People's Hospital
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| Abstract: |
| Objective To investigate the effects of dexmedetomidine on postoperative cognitive dysfunction (POCD) in elderly patients undergoing abdominal surgery under general anesthesia. Methods Ninety one ASA I or Ⅱpatients aged 63~80 yr scheduled for elective abdominal surgery under general anesthesia were randomly divided into two groups: control group (n=45) and dexmedetomidine group (n=46). Anesthesia was induced with midazolam, cisatracurium besilate, fentanil and etomidate in both groups. In dexmedetomidine group, dexmedetomidine was infused over 10 min with loading dose of 0.5滋g/kg and then 0.5滋g·kg-1·h-1 as a maintenance dose. Patients in control group received the same volume of saline istead. Total consumption of anesthetics, operation time, intraoperative blood loss, urine volume and intraoperative fluid input were recorded． Venous blood samples were obtained at 1 d before surgery and 1, 3 and 7 d after surgery for determination of serum TNF-α, IL-1β, IL-6 and high mobility group box-l protein (HMGBl)．The cognitive function was evaluated by Mini-Mental State Examination (MMSE) at all time points．The development of POCD was recorded. Results The consumption of anesthetics was lower in dexmedetomidine group than that in control group (P ＜0.05). Compared to control group, the MMSE scores were significantly increased and serum TNF-α, IL-1β, IL-6 and HMGBl levels were decreased in dexmedetomidine group. Conclusion Dexmedetomidine can suppress the inflammatory cytokines released and reduce the incidence of postoperative cognitive dysfunction． |
| Key words: Dexmedetomidine Postoperative cognitive dysfunction Elderly patients |
